US12004786B2 - Bunion correction system and method - Google Patents

Abstract

A minimally invasive method of correcting a bunion includes performing an osteotomy to divide the metatarsal into first and second portions, implanting a nail in the first portion, securing a suture to the joint capsule, tensioning the suture to align the great toe with the metatarsal, attaching the suture to the nail, and fastening the nail to the second portion. A first guide block includes a plurality of coplanar passages to guide an instrument to create one or more holes in the metatarsal in advance of the osteotomy, and a second guide block includes a guide slot for another instrument to complete the osteotomy. The method can be performed through an incision of 0.5 inches or less. The nail includes an anchor portion for anchoring in the first portion, a head for attachment to a second portion, and can include a passage for attachment of the suture.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a continuation of:

U.S. patent application Ser. No. 16/033,086, entitled BUNION CORRECTION SYSTEM AND METHOD, filed Jul. 11, 2018.

The foregoing is incorporated by reference as though set forth herein in its entirety.

TECHNICAL FIELD

The present invention relates to surgical treatment for deformities of the foot. More specifically, the present invention relates to implants, instrumentation and methods for minimally invasive bunion correction.

BACKGROUND

Bunions are a progressive disorder typically beginning with a leaning of the great toe, which may gradually change the angle of the bones and produce a characteristic bump on the medial side of the metatarsal near the joint of the metatarsal with the proximal phalanx. Specifically, the bunion is the prominence made of bone and at times an inflamed bursa. Hallux valgus is the condition in which the great toe deviates from the normal position toward the direction of the second toe.

Bunion correction or repair is a common surgery with over 100,000 surgeries performed annually in the US. Many surgical procedures for bunion repair are invasive and painful, requiring an incision of several inches and a long period of convalescence, of up to 10-12 weeks. Minimally invasive surgery has been performed in orthopedics for decades. However, creating the bone cuts has been performed with burrs and drill bits inserted blindly through small incisions. This method of surgery lends itself to potential adjacent soft tissue damage and unrepeatable results from patient to patient. The disclosure contained herein seeks to remedy this problem by providing an instrumented technique and guides to provide repeatability and limit the damage to tissue along with a simple implant insertion technique.

Disclosed herein is an implant and method for bunion repair which can be performed as a minimally invasive procedure, thus reducing discomfort, scarring and recovery time in comparison with more invasive bunion correction procedures.

SUMMARY OF THE INVENTION

The various systems and methods of the present invention have been developed in response to the present state of the art, and in particular, in response to the problems and needs in the art that have not yet been fully solved by currently available techniques. The systems and methods of the present invention may provide techniques for bunion correction which result in a streamlined procedure, faster recovery, reduced scarring, and reduced discomfort during healing.

To achieve the foregoing, and in accordance with the invention as embodied and broadly described herein, in a first aspect of the disclosure, a method for correcting a bunion formed at a joint between a metatarsal and a great toe includes selecting a target location on the metatarsal; creating an osteotomy in the metatarsal at the target location, the osteotomy resecting the metatarsal into a first metatarsal portion and a separate second metatarsal portion; implanting an implant into the metatarsal, the implant including a monolithic body having a head and an anchor, wherein implanting the implant into the metatarsal includes inserting the anchor into the intramedullary canal of the first metatarsal portion; securing a length of suture to the great toe; tensioning the suture to re-align the great toe relative to the first metatarsal portion; and attaching the length of suture to the implant head.

Various embodiments of the first aspect can include one or more of the following steps or attributes. Inserting at least one k-wire into the metatarsal adjacent to the target location. Mounting a guide block onto the k-wire, wherein the guide block defines a cutting slot. Actuating a cutting tool through the cutting slot to create the osteotomy in the metatarsal. The cutting tool is selected from the group consisting of a broach, a saw, a blade, a chisel, an osteotome, a curette, a pick, and a rasp. Attaching the implant head to the second metatarsal portion. The incision is 0.5 inch or less in length.

In a second aspect of the disclosure, a method for correcting a bunion formed at a joint between a metatarsal and a great toe includes: selecting a target location on the metatarsal; positioning a guide block at the target location; guiding a cutting instrument with the guide block to create an osteotomy in the metatarsal at the target location, the osteotomy dividing the metatarsal into a first metatarsal portion and a separate second metatarsal portion; implanting an implant into the metatarsal, the implant including a monolithic body having a head and an anchor, wherein implanting the implant into the metatarsal includes inserting the anchor into the intramedullary canal of the first metatarsal portion; securing a length of suture to the great toe; tensioning the suture to re-align the great toe relative to the first metatarsal portion; and attaching the length of suture to the implant head.

Various embodiments of the second aspect can include one or more of the following steps or attributes. Inserting at least one k-wire into the metatarsal adjacent to the target location; mounting the guide block onto the k-wire, wherein the guide block defines a cutting slot; and actuating the cutting instrument through the cutting slot to create the osteotomy in the metatarsal. The cutting instrument is selected from the group consisting of a broach, a saw, a blade, a chisel, an osteotome, a curette, a pick, and a rasp. A joint capsule surrounds the joint, wherein securing the length of suture to the great toe includes securing the length of suture to the joint capsule. Attaching the implant head to the second metatarsal portion. The incision is 0.5 inch or less in length.

In a third aspect of the disclosure, a method for correcting a bunion formed at a joint between a metatarsal and a great toe includes: selecting a target location on the metatarsal; creating an osteotomy in the metatarsal at the target location, the osteotomy dividing the metatarsal into a first metatarsal portion and a separate second metatarsal portion; implanting an implant into the metatarsal, the implant including a monolithic body having a head and an anchor, wherein implanting the implant into the metatarsal includes implanting the anchor into the first metatarsal portion; securing a length of suture to a joint capsule surrounding the joint; tensioning the length of suture to re-align the great toe relative to the first metatarsal portion; attaching the length of suture to the implant head; and fastening the implant head to the second metatarsal portion.

Various embodiments of the third aspect can include one or more of the following steps or attributes. The first metatarsal portion is proximal to the second metatarsal portion. Translating the second metatarsal portion to expose a distal-facing surface of the first metatarsal portion; and inserting the implant anchor through the distal-facing surface into the intramedullary canal of the first metatarsal portion. Abutting the implant head against the distal-facing surface on the first metatarsal portion. The implant head further includes a transverse bore, wherein attaching the length of suture to the implant head includes passing the suture through the transverse bore. Making an incision along a side of the metatarsal before selecting the target location, creating the osteotomy, implanting the implant, securing the length of suture to the joint capsule, tensioning the length of suture, attaching the length of suture to the implant head, and fastening the implant head to the second metatarsal portion; and closing the incision after selecting the target location, creating the osteotomy, implanting the implant, securing the length of suture to the joint capsule, tensioning the length of suture, attaching the length of suture to the implant head, and fastening the implant head to the second metatarsal portion, wherein the suture is a non-resorbable suture, and wherein the length of suture remains secured to the joint capsule and attached to the implant after closing the incision.

These and other features and advantages of the present invention will become more fully apparent from the following description and appended claims, or may be learned by the practice of the invention as set forth hereinafter.

BRIEF DESCRIPTION OF THE DRAWINGS

Exemplary embodiments of the invention will become more fully apparent from the following description and appended claims, taken in conjunction with the accompanying drawings. Understanding that these drawings depict only exemplary embodiments and are, therefore, not to be considered limiting of the invention's scope, the exemplary embodiments of the invention will be described with additional specificity and detail through use of the accompanying drawings in which:

FIG.1A is a perspective view of a bunion correction implant, comprising a nail and a fastener, according to one embodiment of the invention;FIG.1B is an exploded view of the implant;

FIG.2 is a perspective view of a partial skeleton of a foot, with the implant ofFIG.1A implanted into the first metatarsal;

FIG.3A is medial view of the nail ofFIG.1A;FIG.3B is lateral view of the nail ofFIG.1A;FIG.3C is a superior view of the nail ofFIG.1A;

FIG.4 is a perspective view of the foot skeleton with a k-wire inserted into the metatarsal and a first guide mounted on the k-wire, the first guide having a plurality of guide holes;

FIG.5 is a perspective view of the foot skeleton, k-wire and guide ofFIG.4, with additional k-wires inserted into the metatarsal;

FIG.6 is a perspective view of the foot skeleton, k-wires and first guide ofFIG.5, with a trocar extending through one of the guide holes to create a hole in the metatarsal;

FIG.7 is a perspective view of the foot skeleton and k-wires ofFIG.5, with a second guide mounted on the k-wires;

FIG.8 is a perspective view of the foot skeleton, k-wires and second guide ofFIG.7, with a broach extending through a guide slot to cut an osteotomy in the metatarsal and separate the metatarsal into a proximal metatarsal portion and a distal metatarsal portion;

FIG.9 is a perspective view of the foot skeleton ofFIG.8, with the distal metatarsal portion shifted laterally relative to the proximal metatarsal portion;

FIG.10 is a perspective view of the foot skeleton ofFIG.9, with the nail ofFIG.1 mounted on an implant inserter and implanted into the proximal metatarsal portion;

FIG.11A is a medial view of the foot with the nail ofFIG.1 implanted in the proximal metatarsal portion and a needle and suture inserted into the foot through an incision at the site of the implant and exiting at a first location on the great toe at the proximal phalanx;FIG.11B is a medial view of the foot ofFIG.11A, with a first stitch being made at the first location on the great toe;FIG.11C is a medial view of the foot ofFIG.11B, with the needle emerging at a second location on the great toe;FIG.11D is a medial view of the foot ofFIG.11C, with a second stitch being made at the second location on the great toe;FIG.11E is a medial view of the foot ofFIG.11D, with the suture routed through an implant bore, and the needle and suture emerging through the incision, and showing a path of the suture;

FIG.12 is a perspective view of the foot skeleton ofFIG.10 showing the suture and the fastener aimed toward an opening of the nail;

FIG.13A is a perspective view of the first guide ofFIG.5;FIG.13B is a medial view of the first guide ofFIG.5;FIG.13C is a lateral view of the first guide ofFIG.5;FIG.13D is a superior view of the first guide ofFIG.5;FIG.13E is a distal view of the distal end of the metatarsal, the first guide, and the trocar ofFIG.6 extending through another one of the guide holes, with dotted lines indicating the trajectories of the plurality of guide holes;

FIG.14A is a medial perspective view of the second guide ofFIG.7;FIG.14B is a medial view of the second guide ofFIG.7;FIG.14C is a side view of the second guide ofFIG.7;FIG.14D is a lateral perspective view of the second guide ofFIG.7;

FIG.15 is a perspective view of the broach ofFIG.8; and

FIG.16 is a perspective view of the implant inserter ofFIG.10.

DETAILED DESCRIPTION

Exemplary embodiments of the invention will be best understood by reference to the drawings, wherein like parts are designated by like numerals throughout. It will be readily understood that the components of the invention, as generally described and illustrated in the Figures herein, could be arranged and designed in a wide variety of different configurations. Thus, the following more detailed description of the embodiments of the apparatus, system, and method, as represented inFIGS.1A through16, is not intended to limit the scope of the invention, as claimed, but is merely representative exemplary of exemplary embodiments of the invention.

The phrases “connected to,” “coupled to” and “in communication with” refer to any form of interaction between two or more entities, including mechanical, electrical, magnetic, electromagnetic, fluid, and thermal interaction. Two components may be functionally coupled to each other even though they are not in direct contact with each other. The term “abutting” refers to items that are in direct physical contact with each other, although the items may not necessarily be attached together. The phrase “fluid communication” refers to two features that are connected such that a fluid within one feature is able to pass into the other feature.

Directional and/or relational terms such as, but not limited to, left, right, superior, inferior, top, bottom, vertical, horizontal, medial, and lateral are relative to each other, are dependent on the specific orientation of an applicable element or article, are used accordingly to aid in the description of the various embodiments in this specification and the appended claims, and are not necessarily intended to be construed as limiting. Standard medical terminology may be used to describe human anatomy, or the relationship of objects to the human anatomy. For example, proximal refers to an object or anatomical element closer to the center of the body, while distal refers to an object or anatomical element farther away from the center of the body.

The word “exemplary” is used herein to mean “serving as an example, instance, or illustration.” Any embodiment described herein as “exemplary” is not necessarily to be construed as preferred or advantageous over other embodiments. While the various aspects of the embodiments are presented in drawings, the drawings are not necessarily drawn to scale unless specifically indicated.

Referring toFIG.1A, a bunioncorrection implant system100 according to one embodiment of the invention includes anail102 and afastener104. As seen inFIG.2, thenail102 may be implanted to extend longitudinally into aproximal portion2aof a resectedmetatarsal2, and thefastener104 inserted through a portion of the nail to secure it to thedistal portion2bof themetatarsal2. The bunioncorrection implant system100 may further include a suture which may be routed through the medial capsule of the metatarsophalangeal (MTP) joint, secured in the soft tissues of the great toe, tensioned to re-align the position of theproximal phalanx4 relative to the metatarsal, and secured to the nail.

Referring toFIGS.1A-B, and3A-C, theimplant nail102 is a monolithic body extending from afirst end106 which may be a distal end, to asecond end108 which may be a proximal end. Thenail102 may be generally rectangular in cross-section, having amedial side110 which may be an outer side, alateral side112 which may be an inner side, asuperior side114, and aninferior side116. Thenail102 includes ahead120, ananchor122, and aneck124 extending between thehead120 and theanchor122.

With particular reference toFIGS.3B and3C, thenail anchor122 andneck124 extend along alongitudinal axis105, and thenail head120 extends distally away from theneck124 at an angle. The nail head extends between a headfirst end126 and a headsecond end128 along a headfirst axis107. In the embodiment depicted, the angle α between the headfirst axis107 and thelongitudinal axis105 is 15°, with an angle β between the neck lateral surface and the head lateral surface of 165°. In other embodiments of the invention, angle α may be in the range of 0° to 25°. In at least the embodiment depicted, thenail102 and assembledimplant100 are bilaterally symmetrical with respect to thelongitudinal axis105, and with respect to the headfirst axis107.

Thenail head120 includes anopening130 centered on a headsecond axis109, which is perpendicular to the headfirst axis107. The head second axis may extend generally medially-laterally (ML) upon implantation. In the embodiment depicted, theopening130 extends between a headlateral side115 and a headmedial side113, and includesthreads132 for engagement with thefastener104, although additional embodiments may lack threads. Aconcave lip134 encircles theopening130. The headsecond end128 is wider than theneck124 with respect to the superior-inferior dimension, and includes afirst shoulder140 and asecond shoulder142, theshoulders140,142 projecting superiorly and inferiorly, respectively, away from theneck124 at the intersection of the neck and the head. Thefirst shoulder140 includes a firstproximal shoulder surface141, and thesecond shoulder142 includes a secondproximal shoulder surface143. The proximal shoulder surfaces141,143 face proximally away from thehead120 and are at right angles to the neck superior andinferior sides114,116. Thehead120 may further include atransverse bore148, extending along a headthird axis111 which is perpendicular to the headfirst axis107 and the headsecond axis109. The headthird axis111 may extend generally superiorly-inferiorly (SI) upon implantation. In the embodiment depicted, the thickness of thehead120 between its medial113 and lateral115 sides increases between the headfirst end126 and the headsecond end128, so that the thickest part of the head is at theshoulders140,142.

Theneck124 extends between and connects thehead120 with theanchor122. The thickness of theneck124 between the medial110 and lateral112 sides can vary depending on the desired degree of shift of the metatarsal. In at least the embodiment depicted, the neck thickness tapers between thehead120 and theanchor122. The width of theneck124 between the superior114 and inferior116 sides may also vary. The length of the nail between the first and second ends106,108 can vary, as can the relative lengths of the head, neck, and/or anchor portions. Theanchor122 is coaxial with theneck124, and extends from the neck to thesecond end108 of the nail. Both the thickness of the anchor between the medial110 and lateral112 sides, and the width of the anchor between the superior114 and inferior116 sides may taper towards the nail second end, promoting easy insertion of the nail into bone. The anchor terminal end may be rounded as in the embodiment depicted inFIGS.2A and2B; in other embodiments it may be pointed, flattened, serrated, or another shape. Theanchor122 includes a plurality of bone engagement features144 which may be shaped as teeth, scallops, serrations, or other shapes to promote engagement within bone. For example, thescallops146 in the embodiment depicted provide surface irregularities which resist nail backup. In the embodiment shown, the neck and anchor are free from openings; other embodiments could include openings for supplementary fixation or instrument connection.

Fastener104 includes afastener head150,fastener shaft152, andtip154. Thehead150 includesthreads156 for locking engagement withthreads132 in thenail head120; other embodiments may lackthreads156. Theshaft152 includesthreads158 for engagement in bone. Thehead150 may include adriving feature159 for engagement with a driver. In the embodiment depicted,fastener104 is a locking screw type fastener; in other embodiments the fastener may be locking or non-locking, and may be polyaxially adjustable or non-polyaxially adjustable.

Thenail102 andfastener104 may comprise titanium, stainless steel, polyether ether ketone (PEEK), nitinol, and/or other rigid biocompatible materials or combinations thereof. The suture is a non-resorbable suture, although other embodiments may include a resorbable suture.

Referring toFIGS.4-16, a method of correcting a bunion includes one or more of the following steps. Although the steps are described in an order, in other embodiments of the method one or more of the steps may be repeated, omitted, or performed in a different order.

A small incision is made in the affected metatarsal at the medial side of the bunion. Preferably, the incision is 0.5 inch long or less. Referring toFIG.4, a first k-wire159 is introduced through the incision and into the metatarsal at a selected target location. Afirst guide block164 is mounted onto the k-wire159 and urged toward themetatarsal2. Referring toFIG.5, second and third k-wires160,162 are introduced through theguide block164 into the metatarsal, on either side of the selected target location. The second k-wire160 is located in afirst metatarsal portion2a, and the third k-wire162 is introduced into asecond metatarsal portion2b. The first k-wire159 is removed from the metatarsal.

As shown inFIGS.13A-E, thefirst guide block164 extends between a first orlateral side166, and a second ormedial side168. First andsecond guide portions170,172 project superiorly and inferiorly, respectively. A series of guide holes174 extend through the guide block, each defining atrajectory175, which converge at a common point, as seen inFIG.13E. The guide holes174 and theirtrajectories175 are coplanar, defining a cutting plane when thefirst guide block164 is mounted on the k-wires160,162. A pair of mountingholes176,178 are sized to slide over the k-wires. First and second mounting supports180,182 extend medially from theguide block164 and are separated by agap184. The mounting supports180,182 includeslots186,188 for guiding and supporting the k-wires, and prevent rotation of theguide block164 once mounted. Themedial side168 of theguide block164 may be convexly curved as shown.

Referring toFIGS.6 and13E, after thefirst guide block164 is mounted on the k-wires and abuts themetatarsal2, atrocar192, reamer or other instrument is introduced through one of the guide holes174 and inserted into themetatarsal2 to create a hole through the metatarsal along the trajectory of the guide hole. Thetrocar192 may then be inserted through more of the guide holes174 and through the metatarsal. This step creates a linear series of openings through the bone at the targeted location, weakening the bone at that location in preparation for a subsequent osteotomy to resect the metatarsal head. After the desired number of openings are created, thefirst guide block164 is withdrawn from the k-wires.

Referring toFIG.7, asecond guide block200 is introduced onto the k-wires160,162. As shown inFIGS.14A-D, thesecond guide block200 extends between a first orlateral side202, and a second ormedial side204. First andsecond guide portions206,208 project superiorly and inferiorly, respectively. A cuttingslot210 extends through theguide block200, opening out on the lateral andmedial sides202,204, and mountingholes212,214 extend between the medial and lateral sides for mounting the block on the k-wires. Theguide block200 may be curved as shown, wherein themedial side204 of theguide block200 is convexly curved and thelateral side202 is concave. At least the concave lateral surface may allow the guide to fit closely against the targeted location. When thesecond guide block200 is mounted on the k-wires160,162, the mid-plane of the opening defined by the cuttingslot210 is coplanar or at least parallel with the cutting plane defined by the first guide block guide holes174 andtrajectories175, and with the series of openings created in the bone in the previous step.

Referring toFIGS.8 and15, abroach220 is used to create an osteotomy in themetatarsal2, resecting the metatarsal into the first orproximal metatarsal portion2aand the second ordistal metatarsal portion2b. Thebroach220 includes ahandle portion222, ashaft portion224, and a cuttingportion226 with acutting tip228 and cuttingedges230,232. The cutting edges and tip may be beveled, sharpened, serrated and/or otherwise configured to cut through bone. Thebroach cutting portion226 is urged laterally through thecutting slot210 and into the bone to create the osteotomy. Theshaft portion224 may act as a stop to limit lateral insertion of the cutting portion through the cutting slot. In other embodiments of the method, instead of or in combination withbroach220, a saw, blade, chisel, osteotome, curette, pick, rasp or other instrument or combinations thereof may be used to perform the osteotomy. When the osteotomy step is completed, thesecond guide block200 is removed from the k-wires.

Referring toFIG.9, the now separate distalmetatarsal bone portion2bis translated laterally relative to proximalmetatarsal bone portion2a. A generally flat distal-facingsurface2con theproximal metatarsal portion2ais exposed, and it is into this surface that thenail102 is implanted. Distal-facingsurface2cof the proximalmetatarsal bone portion2a, and a medial-facingsurface2dof the distalmetatarsal bone portion2bmay be referred to as abutment surfaces. The degree of offset of the distal metatarsal portion may vary but is sufficient to permit implantation ofnail102 into the distal-facingsurface2cso that thenail head120 does not protrude medially beyond the medial outer surface of theproximal metatarsal portion2aafter implantation. The k-wires160,162 may be removed before or after the shifting of the distal metatarsal portion relative to proximal metatarsal portion.

Referring toFIGS.10 and16, thenail102 is inserted through the incision and anchored into the preparedproximal metatarsal portion2a. Prior to implantation, asuture250 may be introduced to extend through thetransverse bore148. An implant inserter such asinserter240 may be employed to implant thenail102 into the bone.Inserter240 comprises ahandle portion242, ashaft portion244, and animplant engagement end246.Threads248 are formed on theimplant engagement end246, which may cooperate with thenail threads132 to removably attach thenail102 to theinserter240. Theinserter240 is moved to insert theanchor122 andneck124 proximally into the distal-facingsurface2cand into the intramedullary canal of the metatarsal, leaving thehead120 distal to theproximal metatarsal portion2a. If needed, theinserter240 may be tapped to drive thenail102 into position in theproximal metatarsal portion2a. Thenail102 is positioned so that theproximal surfaces141,143 ofshoulders140,142 abut the prepared distal-facingsurface2cof the metatarsal, and the nailhead lateral side115 is immediately adjacent toabutment surface2dof thedistal metatarsal portion2b. When thenail102 is properly seated in the desired location, theinserter240 may be rotated to disengage it from the implantednail102.

Referring toFIGS.11A-11F and12, thesuture250 may be engaged withimplant100 and secured to soft tissues of thegreat toe6 to change the alignment of thephalanx4 relative to themetatarsal2 and correcting hallux valgus. As shown inFIG.11A, aneedle260 carryingsuture250 is introduced through theincision5, enters the medial capsule and emerges at a first location6aon the epidermis of the great toe. The suture includes afirst end252 and asecond end254. As shown inFIG.11B, the needle re-enters the skin at location6a, creating afirst stitch256 in the soft tissue surrounding thephalanx4. Continuing toFIG.11C, theneedle260 andsuture250 emerge at asecond location6bon the epidermis of the great toe. Referring to FIG.11D, theneedle260 andsuture250 re-enter the great toe atlocation6b, creating asecond stitch258 in the soft tissue of thegreat toe6. As shown inFIG.11E, the needle and suturesecond end252 emerge through theincision5. Thesuture250 is tensioned to change the alignment of thephalanx4 relative to themetatarsal2, providing tensile force along the medial side of the phalanx and correcting the hallux valgus. The nail shoulders140,142, abutting against theproximal metatarsal portion2aact as a buttress to support the tension and alignment correction. The tensionedsuture250 is attached to thenail102, with one or both of the first and second ends252,254 passing through thetransverse bore148. The suturefirst end252 may pass through thetransverse bore148 from theinferior side116 to thesuperior side114 of thenail102, and a knot262 may be tied at the superior side of thebore148, maintaining the suture tension and the correction. The knot262 may be wider than the diameter of thetransverse bore148, so that the knot cannot pass through the bore. After knotting, the remaining suture free ends252,254 may be trimmed off. As seen inFIGS.11E and12, thesuture250 may follow a three-sided path from theimplant100 to the first and second stitches in the great toe, and back to theimplant100.

Referring toFIGS.12 and2, thescrew tip154 andshaft152 are inserted through the nail opening130 to secure thenail head120 to thedistal metatarsal portion2b. As theshaft threads158 engage in the bone, thenail head120lateral side115 is urged toabut surface2dof thedistal metatarsal portion2b. Thescrew head threads156 engage with thenail opening threads132 to lock thescrew104 to thenail102. Theincision5 is closed. Following closure of the incision, thesuture250 remains secured to the great toe and attached to theimplant100.

Any methods disclosed herein comprise one or more steps or actions for performing the described method. The method steps and/or actions may be interchanged with one another. In other words, unless a specific order of steps or actions is required for proper operation of the embodiment, the order and/or use of specific steps and/or actions may be modified.

Reference throughout this specification to “an embodiment” or “the embodiment” means that a particular feature, structure or characteristic described in connection with that embodiment is included in at least one embodiment. Thus, the quoted phrases, or variations thereof, as recited throughout this specification are not necessarily all referring to the same embodiment.

Similarly, it should be appreciated that in the above description of embodiments, various features are sometimes grouped together in a single embodiment, Figure, or description thereof for the purpose of streamlining the disclosure. This method of disclosure, however, is not to be interpreted as reflecting an intention that any claim require more features than those expressly recited in that claim. Rather, as the following claims reflect, inventive aspects lie in a combination of fewer than all features of any single foregoing disclosed embodiment. Thus, the claims following this Detailed Description are hereby expressly incorporated into this Detailed Description, with each claim standing on its own as a separate embodiment. This disclosure includes all permutations of the independent claims with their dependent claims.

Recitation in the claims of the term “first” with respect to a feature or element does not necessarily imply the existence of a second or additional such feature or element. Elements recited in means-plus-function format are intended to be construed in accordance with 35 U.S.C. § 112 Para. 6. It will be apparent to those having skill in the art that changes may be made to the details of the above-described embodiments without departing from the underlying principles of the invention.

While specific embodiments and applications of the present invention have been illustrated and described, it is to be understood that the invention is not limited to the precise configuration and components disclosed herein. Various modifications, changes, and variations which will be apparent to those skilled in the art may be made in the arrangement, operation, and details of the methods and systems of the present invention disclosed herein without departing from the spirit and scope of the invention.

Claims (19)

What is claimed is:

1. A method for correcting a bunion formed at a joint between a metatarsal and a great toe, the method comprising:

selecting a target location on the metatarsal;

creating an osteotomy in the metatarsal at the target location, the osteotomy resecting the metatarsal into a first metatarsal portion and a separate second metatarsal portion;

implanting an implant into the metatarsal, the implant comprising a monolithic body having a head and an anchor, wherein implanting the implant into the metatarsal comprises inserting the anchor into the intramedullary canal of the first metatarsal portion;

securing a length of suture to the great toe;

tensioning the suture to re-align the great toe relative to the first metatarsal portion; and

attaching the length of suture to the implant head.

2. The method ofclaim 1, further comprising inserting at least one k-wire into the metatarsal adjacent to the target location.

3. The method ofclaim 2, further comprising mounting a guide block onto the k-wire, wherein the guide block defines a cutting slot.

4. The method ofclaim 3, further comprising actuating a cutting tool through the cutting slot to create the osteotomy in the metatarsal.

5. The method ofclaim 4, wherein the cutting tool is selected from the group consisting of a broach, a saw, a blade, a chisel, an osteotome, a curette, a pick, and a rasp.

6. The method ofclaim 1, further comprising attaching the implant head to the second metatarsal portion.

7. The method ofclaim 1, wherein the incision is 0.5 inch or less in length.

8. A method for correcting a bunion formed at a joint between a metatarsal and a great toe, the method comprising:

selecting a target location on the metatarsal;

positioning a guide block at the target location;

guiding a cutting instrument with the guide block to create an osteotomy in the metatarsal at the target location, the osteotomy dividing the metatarsal into a first metatarsal portion and a separate second metatarsal portion;

implanting an implant into the metatarsal, the implant comprising a monolithic body having a head and an anchor, wherein implanting the implant into the metatarsal comprises inserting the anchor into the intramedullary canal of the first metatarsal portion;

securing a length of suture to the great toe;

tensioning the suture to re-align the great toe relative to the first metatarsal portion; and

attaching the length of suture to the implant head.

9. The method ofclaim 8, further comprising inserting at least one k-wire into the metatarsal adjacent to the target location;

mounting the guide block onto the k-wire, wherein the guide block defines a cutting slot; and

actuating the cutting instrument through the cutting slot to create the osteotomy in the metatarsal.

10. The method ofclaim 8, wherein the cutting instrument is selected from the group consisting of a broach, a saw, a blade, a chisel, an osteotome, a curette, a pick, and a rasp.

11. The method ofclaim 8, wherein a joint capsule surrounds the joint, wherein securing the length of suture to the great toe comprises securing the length of suture to the joint capsule.

12. The method ofclaim 8, further comprising attaching the implant head to the second metatarsal portion.

13. The method ofclaim 8, wherein the incision is 0.5 inch or less in length.

14. A method for correcting a bunion formed at a joint between a metatarsal and a great toe, the method comprising:

selecting a target location on the metatarsal;

creating an osteotomy in the metatarsal at the target location, the osteotomy dividing the metatarsal into a first metatarsal portion and a separate second metatarsal portion;

implanting an implant into the metatarsal, the implant comprising a monolithic body having a head and an anchor, wherein implanting the implant into the metatarsal comprises implanting the anchor into the first metatarsal portion;

securing a length of suture to a joint capsule surrounding the joint;

tensioning the length of suture to re-align the great toe relative to the first metatarsal portion;

attaching the length of suture to the implant head; and

fastening the implant head to the second metatarsal portion.

15. The method ofclaim 14, wherein the first metatarsal portion is proximal to the second metatarsal portion.

16. The method ofclaim 15, further comprising:

translating the second metatarsal portion to expose a distal-facing surface of the first metatarsal portion; and

inserting the implant anchor through the distal-facing surface into the intramedullary canal of the first metatarsal portion.

17. The method ofclaim 16, further comprising abutting the implant head against the distal-facing surface on the first metatarsal portion.

18. The method ofclaim 14, wherein the implant head further comprises a transverse bore, wherein attaching the length of suture to the implant head comprises passing the suture through the transverse bore.

19. The method ofclaim 14, comprising:

making an incision along a side of the metatarsal before selecting the target location, creating the osteotomy, implanting the implant, securing the length of suture to the joint capsule, tensioning the length of suture, attaching the length of suture to the implant head, and fastening the implant head to the second metatarsal portion; and

closing the incision after selecting the target location, creating the osteotomy, implanting the implant, securing the length of suture to the joint capsule, tensioning the length of suture, attaching the length of suture to the implant head, and fastening the implant head to the second metatarsal portion, wherein the suture is a non-resorbable suture, and wherein the length of suture remains secured to the joint capsule and attached to the implant after closing the incision.

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